Mood Congruence and Incongruence in Bipolar Disorder

Classification helps differentiate psychotic episodes

Personality disorder
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Mood incongruence is a term used to describe a serious symptom of bipolar disorder. It is a psychotic feature of the disease wherein the person's belief or action, whether by hallucination or delusion, does not match with his or her mood.

By contrast, mood congruence also describes a psychotic symptom of bipolar disorder, but, in this case, the belief or action are consistent with that person's mood.

While the difference between mood congruence and incongruence may seem of little consequence — given that they both related to a psychotic episode — the way in which each impacts a person's ability to function and thrive can be strikingly different.

Examples of Mood-Incongruent and Mood-Congruent Symptoms

Incongruent means "conflicting." As such, mood incongruence implies that the symptoms conflict with the person's current mood. Examples include:

  • Laughing when your dog dies
  • Believing you have super powers despite going through a major depressive episode

In each case, the actions of the person do not match either the situation or emotional state. The delusion of super powers, for example, in no way coincides with themes of powerlessness that are inherent in depression.

By contrast, congruent means "in agreement." In this case, any symptoms, however extreme, are considered mood-congruent when they in agreement with the person's current mood.

Examples include:

  • Feeling suicidal when your dog dies
  • Believing you have super powers when you are going through a manic episode

However unreasonable the response may be, they nevertheless match the circumstance or emotional state of that person at that moment.

Bipolar Disorder and Psychosis

Within the context of bipolar disorder, both mood congruence and incongruence are used to describe a psychotic feature of the disease.

We don't use mood congruence, for example, to describe a person with bipolar disorder who has a reasonable response to a situation. The terms simply allow us to classify any false beliefs a person may have in order to provide appropriate treatment.

We refer to these false beliefs as psychoses. Psychosis is simply a break from reality, a condition which more often happens during a manic episode and even a depressive episode (but never with a hypomanic episode). Psychosis involves hallucinations (experiencing things that are not real) and/or delusions (believing things that are not real).

Bipolar Disorder and Hallucinations

Most people tend to associate hallucinations with schizophrenia, but they can happen in bipolar disorder, as well. Hallucinations involve experiences or perceptions that are not real, whether they be things a person sees, hears, smells, tastes, or physically feels. Examples include:

  • A mood-congruent hallucination in a depressive episode would involve themes such as guilt or sadness. For example, hearing a voice that tells you that you're worthless.
  • A mood-congruent hallucination in a manic episode would involve grandiosity, like seeing the president in your living room.
  • A mood-incongruent hallucination in a depressive episode would have you experiencing sensations contrary to your depression without any feelings of guilt, death, disease, inadequacy, or deserved punishment.
  • A mood-incongruent episode in a manic episode would be just the opposite, perhaps voices telling you that you're unworthy or deserve punishment.

Delusions, by contrast, are firmly held beliefs that are neither true nor based in reality. They do not involve hallucinations but instead play out in beliefs and actions that are contrary to reality.

Treating People With Bipolar Disorder

Treatment typically involves the management of symptoms and the prevention of mood episodes.

This includes the use of medication (mood stabilizers, antidepressants, antipsychotics) and psychotherapy.

It is important that any person with bipolar disorder receive ongoing care and medical oversight. This is especially true for those experiencing mood-incongruent symptoms in whom the risk of hospitalization and suicide is far greater.

Sources:

Goes, F.; Zandi, P.; Miao, K.; et al. "Mood-Incongruent Psychotic Features in Bipolar Disorder: Familial Aggregation and Suggestive Linkage to 2p11-q14 and 13q21-33." American Journal of Psychiatry. 2007; 164(2):236-47.

Hamshere, M.; Schultze, T.; Schumacher, J.; et al. "Mood-incongruent psychosis in bipolar disorder: conditional linkage analysis shows genome-wide suggestive linkage at 1q32.3, 7p13 and 20q13.31." Bipolar Disorder. 2009; 11(6):610-20

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